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The efficiency of transmission of HIV-1 depends on the infectiousness of the index case and the susceptibility of those exposed. Infectiousness is dictated by the concentration of HIV-1 and the viral genotype and phenotype. People newly infected with HIV-1 (i.e. acute infection) and those with STD co-infections excrete such a large concentration of virus as to be “hyperinfectious”. The probability of HIV-1 transmission may be as low as 1/10,000 episodes of intercourse or 1/10 sexual exposures when anal intercourse is practiced. The transmission of HIV is generally limited a small number of founder variants which themselves may be “hyperinfectious”. Synergistic behavioral and biologic HIV prevention strategies have been developed and implemented. Safer sex includes limiting the number of sexual partners and use of male latex condoms, and these strategies appear to have contributed to reduced HIV-1 incidence in many countries. Biological interventions have proven catalytic: These include voluntary male circumcision and use of antiviral agents either for infected people (who can be rendered less contagious) or as pre- and post-exposure prophylaxis (PrEP and PEP). Ecologic evidence suggests that broader, earlier antiviral treatment of HIV may be reducing incidence in some (but not all) populations. However, maximal benefit of HIV “treatment for prevention” and application of PrEP will likely require a program of universal “test and treat”, where many more infected patients are identified, linked to care, and treated very early in disease and for life. Community randomized trials designed to support this approach are underway in Africa. The “test and treat” prevention strategy is resource intensive and serves to emphasize the urgent need for even more research devoted to HIV-1 vaccine development, or cure of the infection.

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(CIT): The efficiency of transmission of HIV-1 depends on the infectiousness of the index case and the susceptibility of those exposed. Infectiousness is dictated by the concentration of HIV-1 and the viral genotype and phenotype. People newly infected with HIV-1 (i.e. acute infection) and those with STD co-infections excrete such a large concentration of virus as to be "hyperinfectious". The probability of HIV-1 transmission may be as low as 1/10,000 episodes of intercourse or 1/10 sexual exposures when anal intercourse is practiced. The transmission of HIV is generally limited a small number of founder variants which themselves may be "hyperinfectious". Synergistic behavioral and biologic HIV prevention strategies have been developed and implemented. Safer sex includes limiting the number of sexual partners and use of male latex condoms, and these strategies appear to have contributed to reduced HIV-1 incidence in many countries. Biological interventions have proven catalytic: These include voluntary male circumcision and use of antiviral agents either for infected people (who can be rendered less contagious) or as pre- and post-exposure prophylaxis (PrEP and PEP). Ecologic evidence suggests that broader, earlier antiviral treatment of HIV may be reducing incidence in some (but not all) populations. However, maximal benefit of HIV "treatment for prevention" and application of PrEP will likely require a program of universal "test and treat", where many more infected patients are identified, linked to care, and treated very early in disease and for life. Community randomized trials designed to support this approach are underway in Africa. The "test and treat" prevention strategy is resource intensive and serves to emphasize the urgent need for even more research devoted to HIV-1 vaccine development, or cure of the infection.